Pain Points

Indiana’s employers have a drug problem. The good thing is they’re coming clean about it following the release of a sobering study late last year. 

The survey of 200 Indiana-based companies conducted by the National Safety Council and the Indiana Attorney General’s Office revealed that a whopping 80 percent of the state’s employers have had problems with employees abusing prescription opioids such as Vicodin and OxyContin.

“Beyond the loss of productivity, prescription abuse can cause impairment, injury and may lead employees to bad choices, such as theft and embezzlement from the employer,” said Indiana Attorney General Greg Zoeller in a news release about the December 2015 study.

As Indiana stares down its once-dirty little secret, the bigger drug problem is that prescription painkiller abuse isn’t limited to the Hoosier state and has reached crisis levels across the United States. In addition to endangering the health and well-being of millions of employees, growing mounds of data show it’s costing employers billions of dollars in absenteeism and lost productivity.

Some in the medical community complain that formal training to prescribe the drugs is lacking while governmental guidance is vague. Others point to medical marijuana as a potential remedy. With firm solutions to the problem being elusive, the U.S. Centers for Disease Control and Prevention nonetheless sounded the alarm.

“Opioid abuse, including prescription painkillers, is a growing epidemic that is gripping our country,” said Dr. Tom Frieden, the director of the CDC, in an email.

According to the CDC’s most recent data, 2 million Americans aged 12 or older either abused or were dependent on opioid pain relievers in 2013. According to recent CDC analysis, 28,600 people died in 2014 because of overdoses from prescription painkillers, heroin and other opioids.

“We would expect very similar results in many states,” said Deborah Hersman, president and CEO of the National Safety Council, during a news conference at the Indiana Statehouse. The Illinois-based nonprofit organization focuses on preventing injuries and deaths at work and in the community regarding the Indiana employer survey. “This is not a local problem. This is a national problem, and it’s very important for employers to understand that this is an issue that they need to pay attention to and not put their heads in the sand.”

On average, opiate misuse costs the U.S. economy $55.7 billion a year, according to the American Society of Addiction Medicine. Employers shoulder nearly half of that cost and lose an average of $10 billion from lost work and productivity alone.

While they bear the financial burden of their employees’ prescription drug abuse, employers are also in an ideal position to ease their own pain.

“Opioid misuse costs employers in multiple ways,” said Jeff O’Mara, president and CEO of Healthentic, a Seattle-based health analytics company, in a news release. But “employers have a unique opportunity to help people get more productivity for less money by identifying and engaging the people at risk.”

Power of the Flower

Opioids are a class of drugs derived from opium, a gummylike substance collected from the seed of the opium poppy. While the flower itself is beautiful, the chemical it produces is powerful and is most often prescribed for the treatment of chronic pain resulting from disease, surgery or injury and is also used to battle severe coughs or diarrhea, according to the Center for Addiction and Mental Health.

“They act by attaching to specific proteins called opioid receptors, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract and other organs in the body,” said Dr. Nora Volkow of the National Institute on Drug Abuse during congressional testimony last year. “When these drugs attach to their receptors, they reduce the perception of pain and can produce a sense of well-being. They can also produce drowsiness, mental confusion, nausea and constipation.”

Drowsiness and confusion are employers’ top two concerns, especially in fields involving manual labor, Volkow said. Opioids impede an employee’s ability to operate heavy machinery and make logical decisions, especially if the drug is being abused.

While highly effective, the drug is also highly addictive. Opioids can produce a sense of pleasure because these drugs affect brain regions involved in reward, Volkow said. Adding to their danger is the fact that opioids tend to induce tolerance, which means that over time a larger dose is needed to achieve the initial effect.

“This tolerance contributes to the high risk of overdose  during a relapse to opioid use after a period in recovery,” Volkow said during her testimony. “Users who do not realize they may have lost their tolerance during a period of abstinence may initially take the high dosage that they previously had used before quitting, which produces an overdose in the person who no longer has tolerance.”

According to the American Society of Addiction Medicine, opiate poisoning increased by 91 percent from 1999 to 2012. For comparison, heroin poisonings increased by just over 12 percent during that time period.

Adding insult to injury is the fact that there are no federal guidelines regulating the prescription of opioid drugs for chronic pain. Primary-care physicians say they receive insufficient training in prescribing opioid pain relievers, which suggests that many prescriptions are being written unnecessarily.

Employers Feel the Pain

The effect of prescription drug abuse on employers is twofold. First, employees who abuse opioid drugs use significantly more health care resources than nonopioid users. Costs for opioid painkillers rose 11.5 percent in 2014, according to pharmacy benefit manager Express Scripts Holding Co. As a result, workers’ compensation claim payers spent an average of $1,583 per injured worker for prescription drugs in 2014, which is up almost 2 percent from 2013.

Furthermore, opioid abusers have significantly higher health care costs than nonabusers — $10,627 annually — according to a research article in The Journal of Managed Care & Specialty Pharmacy.

Absenteeism and lost wages costs employers an estimated$10 billion nationwide each year, added J. Bradford Rice, analyst for Analysis Group in Boston.

O’Mara said that while employers feel the financial pain of opioid abuse, there are steps they can take to alleviate its impact in the workplace.

“And it starts with understanding the employee population,” O’Mara said. “Only 13 percent of an employee population with an opioid prescription is likely to abuse it, but employers can look for specific warning signs to sift out those individuals.”

These warning signs include 10 or more opioid prescriptions a year and a prescribed supply of 120 days or more.

Then there are steps employers can take to ensure the long-term health of employees while saving on productivity and employment costs, O’Mara said. The first is to understand and insist on conservative prescribing guidelines for pain treatments for all participating providers in their medical, workers’ compensation and occupational health programs.

Employers should also invest in educating employees about the risks of opioid drug use to help preempt drug misuse, O’Mara added.

“Whether it’s pamphlets or bringing in speakers, employers need to start a conversation about drug abuse and how to avoid it,” he said.

Finally, employers should ensure confidential access to help treat employees who find themselves in a position of opioid dependency.

“Help needs to be clear and accessible to any employee that finds they have a problem with opioid abuse,” O’Mara said. “Employee-sponsored treatment is often more effective than treatment recommended by family or friends. It’s good for morale, and retaining employees is beneficial to employers.”

Another Organic Option

While there are steps employers can take to ensure employees are using opioids safely and effectively, experts are always on the lookout for safe alternatives. And recent research suggests that the best option is slightly nontraditional. Experts are touting medical marijuana as an effective substitute for addictive opioids.

In July 2015, the Minnesota Department of Labor and Industry adopted a rule establishing criteria for long-term opioid treatment that also said medical marijuana is not an illegal substance for injured workers under state law. 

The U.S. Food and Drug Administration has not yet approved marijuana for any medical condition, so it’s difficult to compare its effects with other drugs used in workers’ compensation. However, physicians specializing in the treatment of addiction, such as Dr. Damon Raskin, a Los Angeles-based internist, realize marijuana carries a somewhat lowered health risk to users than opioids.

“Although marijuana can be helpful for pain in some cases, there is no good scientific evidence backing this up, and more research needs to be done,” Raskin said. “Of course marijuana is safer than opiates in that there is no risk of respiratory suppression and death, but still has addiction potential.”

And in an article in the Journal of the American Medical Associationin June 2015, Dr. Amy Thompson states that, “so far, evidence suggests that marijuana may be an effective treatment for chronic pain, neuropathic pain and muscle spasms due to multiple sclerosis or paraplegia.”

The issue has even made its way to the New Mexico state court of appeals. An appellate court judge sided with physicians who supported the use of medical marijuana when opioids failed to relieve the chronic pain of an injured worker.

Until marijuana receives legal status in the United States, it will be difficult to make a case that its use is reasonable and necessary for workplace pains. Until that time, physicians such as Raskin and Volkow urge colleagues and employers alike to remember that there are pain-fighting options with little addiction potential. 

“Much better alternatives for pain include nonsteroidal anti-inflammatory drugs, nerve blockers, and other medicines including anti-seizure drugs and antidepressants which have pain-relieving properties,” Raskin said. “Physical therapy, massage and acupuncture all have roles to reduce pain in work-related injuries. Marijuana may have a role in the future for chronic pain, but a lot more research needs to be done.”

A 2015 Healthentic study on the cost of painkiller abuse on U.S. companies found that for pain related to common workplace injuries such as soft-tissue injuries such as bruises and musculoskeletal problems that affect muscles, bones and joints, opioids are no more effective at reducing pain than over-the-counter alternatives such as Tylenol, Advil or generic ibuprofen.

“At the end of the day, we believe zero workplace incidents is the only ethically responsible target,” said the National Safety Council’s Hersman during a news conference. “We have a duty to protect employees from harming themselves and harming others.”